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Conditional Vasospasm-Free Survival Following Aneurysmal Subarachnoid Hemorrhage.
Kelly, Patrick D; Yengo-Kahn, Aaron M; Tang, Alan R; Jonathan, Sumeeth V; Reynolds, Rebecca A; Ye, Fei; Zhao, Zhiguo; Froehler, Michael T; Fusco, Matthew R; Morone, Peter J; Chitale, Rohan V.
Afiliación
  • Kelly PD; Department of Neurological Surgery, Vanderbilt University Medical Center, Vanderbilt University Medical Center, North T-4224, 1161 21st Avenue South , Nashville, TN, 37212, USA. patrick.d.kelly@vumc.org.
  • Yengo-Kahn AM; Department of Neurological Surgery, Vanderbilt University Medical Center, Vanderbilt University Medical Center, North T-4224, 1161 21st Avenue South , Nashville, TN, 37212, USA.
  • Tang AR; Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN, USA.
  • Jonathan SV; Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN, USA.
  • Reynolds RA; Department of Neurological Surgery, Vanderbilt University Medical Center, Vanderbilt University Medical Center, North T-4224, 1161 21st Avenue South , Nashville, TN, 37212, USA.
  • Ye F; Department of Biostatistics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA.
  • Zhao Z; Department of Biostatistics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA.
  • Froehler MT; Department of Neurological Surgery, Vanderbilt University Medical Center, Vanderbilt University Medical Center, North T-4224, 1161 21st Avenue South , Nashville, TN, 37212, USA.
  • Fusco MR; Department of Neurological Surgery, Vanderbilt University Medical Center, Vanderbilt University Medical Center, North T-4224, 1161 21st Avenue South , Nashville, TN, 37212, USA.
  • Morone PJ; Department of Neurological Surgery, Vanderbilt University Medical Center, Vanderbilt University Medical Center, North T-4224, 1161 21st Avenue South , Nashville, TN, 37212, USA.
  • Chitale RV; Department of Neurological Surgery, Vanderbilt University Medical Center, Vanderbilt University Medical Center, North T-4224, 1161 21st Avenue South , Nashville, TN, 37212, USA.
Neurocrit Care ; 37(1): 81-90, 2022 08.
Article en En | MEDLINE | ID: mdl-35099712
BACKGROUND: Following aneurysmal subarachnoid hemorrhage (SAH), patients are monitored closely for vasospasm in the intensive care unit. Conditional vasospasm-free survival describes the risk of future vasospasm as a function of time elapsed without vasospasm. Conditional survival has not been applied to this clinical scenario but could improve patient counseling and intensive care unit use. The objective of this study was to characterize conditional vasospasm-free survival following SAH. METHODS: This was a single institution, retrospective cohort study of patients treated for aneurysmal SAH between 1/1/2000-6/1/2020. The primary outcome was the development of vasospasm defined by the first instance of either radiographic vasospasm on computed tomography angiography, Lindegaard Index > 3.0 by transcranial doppler ultrasonography, or vasospasm-specific intraarterial therapy. Multivariable Cox regression was performed, and conditional vasospasm-free survival curves were constructed. RESULTS: A total of 528 patients were treated for aneurysmal SAH and 309 (58.5%) developed vasospasm. Conditional survival curves suggest patients who survive to postbleed day 10 without vasospasm have a nearly 90% chance of being discharged without vasospasm. The median onset of vasospasm was postbleed day 6. Age more than 50 years was associated with a lower risk (hazard ratio [HR] = .76; 95% confidence interval [CI] 0.64-0.91; p < 0.001). Higher initial systolic blood pressure (HR = 1.18; 95% CI 1.046-1.350; p = .008), Hunt-Hess grades 4 or 5 (HR = 1.304; 95% CI 1.014-1.676), and modified Fisher scale score of 4 (HR = 1.808; 95% CI 1.198-2.728) were associated with higher vasospasm than the respective lower grades. CONCLUSION: Conditional survival provides a useful framework for counseling patients and making decisions around vasospasm risk for patients with aneurysmal SAH, while risk factor-stratified plots facilitate a patient-centric, evidence-based approach to these conversations and decisions.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedades del Sistema Nervioso Autónomo / Hemorragia Subaracnoidea / Vasoespasmo Intracraneal Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans / Middle aged Idioma: En Revista: Neurocrit Care Asunto de la revista: NEUROLOGIA / TERAPIA INTENSIVA Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedades del Sistema Nervioso Autónomo / Hemorragia Subaracnoidea / Vasoespasmo Intracraneal Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans / Middle aged Idioma: En Revista: Neurocrit Care Asunto de la revista: NEUROLOGIA / TERAPIA INTENSIVA Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos